If one was to create a word cloud of the most used phrases around the NHS in 2015, ‘seven-day sevices’ would easily be one of the most prominent.
Much has been said about the impact of a seven-day NHS on doctors, consultants and hospital nurses but what impact will be expected of primary care nurses?
Health secretary Jeremy Hunt is keen to remind us that he hasn’t forgotten about nurses. One might be forgiven for thinking this was the case, amid the junior doctor dispute still under arbitration as Independent Nurse went to press.
‘Absolutely not,’ he reassures Independent Nurse. ‘[Nurses and healthcare assistants] will continue to have a central role in this government’s vision for the future of the NHS,’ he adds.
The offering of a seven-day service is essentially about giving patients a choice. To give them the opportunity to access a healthcare professional the moment they fall ill or become injured. ‘This does not mean that nurses will be expected to work every day, or every weekend and evening,’ says Mr Hunt.
Instead he envisions practices working together to deliver more convenient and accessible services for patients including through innovative use of technology and better use of skill mix. Work is also being undertaken by Health Education England (HEE) to look at what additional workforce will be required across the system, he tells us.
Workforce numbers are a sore point with nurses at the moment as last month chancellor George Osborne announced that student nurse bursaries would be replaced by student loans.
This was met with concern from nursing organisations and nurses themselves that students would be deterred from applying for nursing.
Mr Hunt stands firm that the current system of bursaries was not supplying the number of nurses the NHS needs. ‘Students are turned away from nursing places and there are too many vacancy rates in Trusts,’ he says.
However, following a petition created by a student nurse which had reached 137,643 signatures at the time of publication, parliament has agreed to a debate on 11 January. With the BMA’s negotiators threatening to lift the stay of execution on its junior doctor strike on 13 January, it is a week which could define Mr Hunt’s still considerable political ambitions (some Westminster pundits have touted him as an outside bet for next leader, but Tory insiders say his ultimate goal is foreign secretary).
Training the future
When seven-day services is coupled with one of the other 2015 NHS buzzwords, community care, primary care nurses begin to take an even stronger shape.
‘Longer term, we are focusing on keeping people well and out of hospital. Nurses working in the community are an important part of this. That is why we are increasing the number of training places for district nurses by over 15%,’ the health secretary says.
He states that multiple partner organisations are working with HEE including NHS England, Public
Health England and the Department [of Health] to progress the shared Community Nursing Strategy, which includes reviewing the work for practice nursing, Mr Hunt says. He mentions that a fundamental component of that work is to ensure that all student nurses have the opportunity to undertake a primary care placement during their training and that experienced non-community based nurses can be equipped to undertake work in primary care.
This focus on increasing nursing numbers also targets returners as HEE has invested £5million in a new campaign to get experienced nurses back to work and their ongoing plans should see nursing numbers grow year on year to make 23,000 more nurses available by 2019, according to the health secretary.
Here and now
However, to implement Mr Hunt’s future vision of the NHS of seven-day care in the community the current nursing workforce will be the most crucial in the early days.
This becomes even more apparent when joined with some other favourite phrases from the Jeremy Hunt word cloud – patient safety and safe staffing.
But does Mr Hunt really think that achieving these aspirations can happen in the face of budget cuts and nursing shortages?
‘I think the evidence is clear that at a time when budgets are stretched – though let’s remember that the government is investing nearly £4billion in the NHS next year – unsafe care is one of the most expensive things you can do,’ he says.
NICE guidance will continue to be used by NHS Trusts to help them look at their approach to staffing and decide what is best for patients, and NHS Improvement will take forward new guidance on safe staffing, he adds.
A part of the primary care nursing workforce that has previously been considered ‘invisible’ by Independent Nurse readers (IN, 15 June 2015, pg17) are advanced nurse practitioners. How does Mr Hunt plan to grow this part of the nursing workforce to help meet the changing needs of the population and provide a sustainable solution to the GP workforce shortage?
He says that many GP practices are already including nurse prescribers and nurse practitioners in multi-disciplinary teams, and experience suggests that there have been significant benefits for patients and practice teams.
‘For example, in Erewash advanced nurse prescribers have helped patients avoid unplanned admissions to hospitals as well as freeing up GP time.
‘In Cannock, nurse practitioners in the surgery see and treat minor illness cases and provide health advice to empower patients to assist in managing their own care,’ he says. As well as reeling off these specific examples, Mr Hunt tells us that there are a number of pilots across the country to determine new ways of working which includes increasing the use of advanced nurse practitioners.
Clinical focuses
Since Mr Hunt was appointed health secretary in 2012, one of his key priorites has been tackling dementia diagnosis and working towards a cure by 2025. He chaired the first G8 Summit for dementia in December 2013 which set a series of goals to bring down rates of dementia. ‘The fact is that a new diagnosis of dementia takes place every four seconds – and I think too often it is ignored, down-played or mistaken as a part of the ageing process,’ he reveals as one of the reasons behind its choice as a focus for this government.
2016 will see Mr Hunt set his sights on tackling childhood obesity due to the fact that obesity is ‘probably the biggest public health challenge facing our generation.’ Mr Hunt says that a comprehensive strategy to tackle childhood obesity will be published in the new year.
Noticeably, the Labour party has appointed a shadow cabinet minister specifically for mental health, a step that the Conservatives have not taken. In the previous Coalition government it was Norman Lamb, former minister for care and support and a Lib Dem MP, that was one of the biggest advocates for achieving parity of esteem between mental and physical health. What is the current government doing to tackle a condition that currently affects one in four people?
Mr Hunt says: ‘Ultimately, I think it’s a case of “show, not tell” – so we have given the NHS more money than ever before for mental health, we are introducing access and waiting time targets for mental health for the first time and we changed the law so mental health and physical health are given equal priority in our health service.’
Challenges abound the NHS in the next few years. While the spending review revealed that more money would be put in the NHS, we questioned the health secretary on whether the NHS was equipped to meet the challenge of treating the country for free at the point of use.
‘I absolutely believe in a tax-funded NHS, free at the point of use – it’s a key part of the social contract we have with the British people, and this government is totally committed to NHS values. But we are also clear that the NHS must hold up its side of the deal set out in the Forward View to generate efficiencies that mean we can spend every penny possible on patient care.’
It will be interesting to see which words dominate the NHS word cloud for 2016. But the chances are they will be from Mr Hunt’s playbook.